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Virtual simulation of neuroendoscopic procedures: early clinical experience with ventricular lesions.
[hydrocephalus with stenosis of the aqueduct of sylvius]
Virtual
endoscopy
(
VE
)
is
a
new
and
promising
imaging
technology
.
Applied
to
neuroendoscopy
it
allows
preoperative
simulation
of
a
procedure
and
evaluation
of
the
individual
intraventricular
anatomy
in
selected
cases
.
Along
with
neuronavigation
and
real
time
intraoperative
imaging
,
VE
is
expected
to
improve
the
safety
and
efficacy
of
neuroendoscopic
procedures
.
Between
April
2003
and
February
2004
VE
simulation
was
performed
in
13
randomly
selected
patients
subjected
to
endoscopic
procedures
.
Pathological
entities
included
4
cases
with
aqueduct
stenosis
,
4
with
suprasellar
arachnoid
cysts
,
2
tumors
of
the
posterior
third
ventricle
,
1
colloid
cyst
,
1
hyperplasia
of
the
choroid
plexus
and
1
case
with
multiloculated
hydrocephalus
due
to
intraventricular
septations
.
In
8
patients
VE
was
accomplished
preoperatively
,
in
another
5
it
was
done
after
the
operation
,
using
data
sets
from
neuronavigation
imaging
planning
in
4
patients
,
and
in
one
case
using
postoperative
imaging
studies
.
T
(
1
)
-
weighted
3
D
image
sets
were
acquired
on
a
1
.
5
T
GE
Genesis
SIGNA
MR
scanner
and
VE
reconstruction
was
performed
using
the
General
Electric
Navigator
software
.
The
VE
images
were
compared
with
the
real
images
obtained
during
the
endoscopic
procedures
and
evaluated
for
their
impact
on
the
planning
of
the
operative
approach
.
VE
implementation
succeeded
in
all
13
patients
.
Major
neuroanatomic
reference
structures
were
easily
recognizable
in
all
cases
.
Membranous
structures
such
as
the
thinned
floor
of
the
third
ventricle
or
cyst
walls
were
identifiable
in
only
46
%
of
the
cases
.
In
6
cases
(
46
%
)
VE
showed
anatomical
variants
and
details
relevant
for
the
endoscopic
procedure
that
were
not
identified
on
conventional
MR
images
.
VE
has
proved
to
be
an
important
adjunct
to
the
preoperative
planning
of
neuroendoscopic
procedures
and
its
routine
application
is
suggested
.